Tissue Welding Forceps Usage in Superficial Parotidectomy: A Clinical Assessment

2008 ◽  
Vol 74 (1) ◽  
pp. 51-55
Author(s):  
Randall G. Michel ◽  
Kang Tsau ◽  
Bernard I. Weinstock
Keyword(s):  
Blood Loss ◽  
Blood Vessel ◽  
Surgical Procedures ◽  
Clinical Assessment ◽  
Facial Weakness ◽  
Facial Paresis ◽  
Superficial Parotidectomy ◽  
Safety And Efficacy ◽  
Tissue Welding ◽  
Estimated Blood Loss

Tissue welding forceps (TWF) have been used effectively in a number of surgical procedures including blood vessel harvesting and tonsillectomy. Our objective was to assess the safety and efficacy of TWF usage in superficial parotidectomy. We performed a retrospective review of 25 patients between November 2002 and July 2006 who underwent superficial parotidectomy using TWF. The inpatient and outpatient records were reviewed for diagnosis, operative times, estimated blood loss, and postoperative facial paresis. Only one of the 25 patients (4%) who underwent superficial parotidectomy using TWF had transient postoperative facial weakness and no procedure had blood loss of greater than 150 cc. This initial evaluation suggests that use of TWF is safe in superficial parotidectomy and may help reduce the development of postoperative facial paresis.

Safety and Efficacy of Laparoscopic Liver Resection for Colorectal Liver Metastasis With Obesity

2020 ◽  
pp. 000313482095244
Author(s):  
Yoshihiro Inoue ◽  
Masatsugu Ishii ◽  
Kensuke Fujii ◽  
Kentaro Nihei ◽  
Yusuke Suzuki ◽  
...  
Keyword(s):  
Liver Resection ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Operative Time ◽  
Surgical Site Infections ◽  
Obese Patients ◽  
Visceral Fat Area ◽  
Safety And Efficacy ◽  
Estimated Blood Loss ◽  
Significant Difference

Introduction Laparoscopic liver resection (LLR) in obese patients has been reported to be particularly challenging owing to technical difficulties and various comorbidities. Methods The safety and efficacy outcomes in 314 patients who underwent laparoscopic or open nonanatomical liver resection for colorectal liver metastases (CRLM) were analyzed retrospectively with respect to the patients’ body mass index (BMI) and visceral fat area (VFA). Results Two hundred and four patients underwent LLR, and 110 patients underwent open liver resection (OLR). The rate of conversion from LLR to OLR was 4.4%, with no significant difference between the BMI and VFA groups ( P = .647 and .136, respectively). In addition, there were no significant differences in terms of operative time and estimated blood loss in LLR ( P = .226 and .368; .772 and .489, respectively). The incidence of Clavien-Dindo grade IIIa or higher complications was not significantly different between the BMI and VFA groups of LLR ( P = .877 and .726, respectively). In obese patients, the operative time and estimated blood loss were significantly shorter and lower, respectively, in LLR than in OLR ( P = .003 and < .001; < .001 and < .001, respectively). There was a significant difference in the incidence of postoperative complications, organ/space surgical site infections, and postoperative bile leakage between the LLR and OLR groups ( P = .017, < .001, and < .001, respectively). Conclusion LLR for obese patients with CRLM can be performed safely using various surgical devices with no major difference in outcomes compared to those in nonobese patients. Moreover, LLR has better safety outcomes than OLR in obese patients.

Safety and Efficacy of Plasma Derived Factor IX in Patients with Hemophilia B Undergoing Surgical Intervention: A Single Institution, Retrospective Analysis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4438-4438
Author(s):  
Laurence Logan ◽  
Doris V. Quon
Keyword(s):  
Blood Loss ◽  
Surgical Procedures ◽  
Surgical Intervention ◽  
Factor Ix ◽  
Patient Choice ◽  
Hemophilia B ◽  
Postoperative Treatment ◽  
Safety And Efficacy ◽  
Blood Replacement ◽  
Perioperative Blood Loss

Abstract Abstract 4438 Introduction Hemophilia B patients often require orthopedic surgical intervention for the improvement of function and quality of life. In these patients, coagulation factor replacement is essential, but the safety and efficacy of plasma-derived factor IX in controlling bleeding during surgeries has been little studied. Issues of particular concern for surgical intervention include appropriate dosing of factor concentrate, pharmacokinetics, and safety considerations. Objective The purpose of this study was to examine outcomes in patients with hemophilia B following surgical intervention and treatment with plasma-derived factor IX. Method Following IRB approval, 22 patients who underwent 31 surgical procedures at the Hemophilia Treatment Center at Orthopedic Hospital or its affiliates in Los Angeles, CA, during the period 1996 to present, were identified. Once identified, inpatient charts for these patients were reviewed and abstracted. Outcomes of interest included pre- and post operative dosing of factor IX, perioperative blood loss and use of blood products, pharmacokinetics factors, and hemostatic response. Results For identified patients, 9.1% were diagnosed with mild hemophilia B (factor IX levels > 5%), 13.6% had moderate hemophilia B (factor IX levels between 1% - 5%), and 77.3% had severe hemophilia B (factor IX < 1%). The mean age at surgery was 48.0 years old. All but 3 surgical procedures were orthopedic (90.3%) and most frequently involved the knee (38.7%), elbow (16.1%), hip (12.9%), or shoulder (9.6%). All surgeries were completed under general anesthesia and average time in surgery was 3:15 hours. Dose of factor IX averaged 238 IU/kg on the day of surgery and was adjusted over the course of the hospital stay. Selection of replacement factor IX was by patient choice and AlphaNine® SD was the most common factor IX concentrate used (94% of procedures). Mean perioperative blood loss was 283ccs (range 0-1000) and blood replacement was required in only 2 surgeries (6.5%). Pharmacokinetic analysis performed pre-operatively related well to factor IX levels obtained peri- and post-operatively. Average hospital length of stay was 10.7 days and all patients were discharged to home. Conclusion The results of this study demonstrated that patients with Hemophilia B undergoing major surgery who were treated with plasma derived factor IX had little unexpected blood loss perioperatively, seldom required blood replacement, and had no bleeding related surgical complications. These results suggest that pre- and postoperative treatment with plasma derived factor IX is both safe and effective for patients with hemophilia B undergoing surgical intervention. Disclosures: Logan: Grifols, S.A.: Consultancy. Quon:NovoNordisk: Speakers Bureau; Grifols, S.A.: Honoraria.

scholarly journals Assessment of Intraoperative Blood Loss during Oral and Maxillofacial Surgical Procedures in a Nigerian Tertiary Health Care Center

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Babatunde O. Akinbami ◽  
Bisola Onajin-Obembe
Keyword(s):  
Blood Loss ◽  
Surgical Procedures ◽  
Significant Relationship ◽  
Cleft Lip ◽  
Soft Tissues ◽  
Care Center ◽  
Mean Value ◽  
Health Care Center ◽  
Estimated Blood Loss ◽  
Duration Of Surgery

Background. Reports on estimated amount of blood loss in maxillofacial surgical procedures will guide clinicians through units of blood required for each procedure. The aim of the study was to assess the amount of blood loss and duration of surgery. Methods. All cases of maxillofacial surgical procedures done under GA in the MFU theatre, from January 2007 to December 2013, were included in the study. Pre- and postoperative haematocrit values, number of units of whole blood requested and used, amount of blood loss, and duration of surgery were recorded. Results. 139 patients were analyzed, of which 75 (54.0%) were males and 64 (46.0%) were females. Fifty-six (40.3%) cases involved soft tissues. Eighty-three cases involved hard tissues. Age range was 2 months to 78 years; mean ± (SD) was 21.3±(18.5) years. Isolated unilateral cleft lip had the lowest mean value of estimated blood loss of 10.4±10.8 mLs and also the lowest duration of surgery of 58 (76) minutes. There was no significant relationship between both parameters for cleft lip. Fractures of the mandible had mean blood loss of 352 mLs and duration was 175 min. Conclusion. In this study, there was significant relationship between estimated blood loss and duration of surgery for mandibular and zygomatic complex fractures.

Low Morbidity Associated With the Use of Nbca Liquid Adhesive for Preoperative Transarterial Embolization of Central Nervous System Tumors

Neurosurgery ◽  
2006 ◽  
Vol 59 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Louis J. Kim ◽  
Felipe C. Albuquerque ◽  
Ali Aziz-Sultan ◽  
Robert F. Spetzler ◽  
Cameron G. McDougall
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Blood Loss ◽  
Transarterial Embolization ◽  
Cns Tumors ◽  
Neurological Deficits ◽  
Preoperative Embolization ◽  
Tumor Type ◽  
Safety And Efficacy ◽  
Estimated Blood Loss

Abstract OBJECTIVE To determine the safety and efficacy of preoperative embolization of central nervous system (CNS) tumors with n-butyl cyanoacrylate (NBCA) liquid adhesive. METHODS Over a 6-yr period, 35 consecutive patients (12 women, 23 men; mean age, 42 yr; range, 6 mo to 75 yr) with a CNS tumor underwent preoperative embolization with NBCA. Tumor type, location, endovascular and surgical treatment, percent of tumor embolization, estimated blood loss, and neurological deficits related to embolization were evaluated retrospectively. RESULTS One hundred feeding arteries were embolized (mean, 3 vessels/patient). In only one case (3%) a normal artery was inadvertently occluded by the embolization. During follow-up the resulting neurological deficit resolved completely. There were no neurological deficits or inadvertent embolization events in the remaining 34 cases. The mean percent of tumor embolized was 68%, but did not significantly correlate with operative blood loss (Pearson's correlation coefficient, r = 0.049). CONCLUSION In experienced hands, CNS tumors can be embolized with NBCA liquid adhesive with a high degree of safety and efficacy. We believe that adroit embolization technique with NBCA and other embolisates should be part of the contemporary neuroendovascular armamentarium.

scholarly journals Impact of tranexamic acid use on blood loss and transfusion rates following femoral varus derotational osteotomy in children with cerebral palsy

2019 ◽  
Vol 13 (2) ◽  
pp. 190-195 ◽  
Author(s):  
A. Nazareth ◽  
S. J. Shymon ◽  
L. Andras ◽  
R. Y. Goldstein ◽  
R. M. Kay
Keyword(s):  
Cerebral Palsy ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Thromboembolic Complications ◽  
Safety And Efficacy ◽  
Estimated Blood Loss ◽  
Transfusion Requirements ◽  
Derotational Osteotomy ◽  
Venous Thromboembolic Events ◽  
Children With Cerebral Palsy

Purpose Previous studies have established the safety and efficacy of tranexamic acid (TXA) in reducing blood loss after total joint arthroplasty and spinal fusion surgery; however, literature regarding the effectiveness of intraoperative TXA in children with cerebral palsy (CP) is limited. The aim of this study was to investigate the safety and efficacy of intraoperative TXA in reducing blood loss and transfusion requirements for children with CP undergoing a proximal femoral varus derotational osteotomy (VDRO). Methods This is a retrospective review of 258 children with CP who underwent VDRO performed at the author’s institution between 2004 and 2017. In all, 36 subjects underwent VDRO surgery with administration of intravenous TXA and 222 subjects underwent VDRO without administration of TXA. Outcome measures including blood loss, transfusion requirements and venous thromboembolic events were compared between groups using t-tests and chi-squared tests. Results No significant differences were seen in the rates of transfusion between groups for the entire hospitalization (TXA group: 11.1% versus No TXA group: 19.8%), intraoperatively (TXA: 2.8% versus No TXA: 9.0%) or postoperatively (TXA: 8.3% versus No TXA: 14.4%). Intraoperative estimated blood loss (TXA: 144.4 mL versus No TXA: 159.0 mL) and percentage blood loss (TXA: 8.9% versus No TXA: 9.2%) were similar between groups. No major thromboembolic complications events occurred in either group. Conclusion The use of TXA was not associated with thromboembolic complications in this series of children with CP undergoing VDRO surgery. Though there was a trend toward lower rates of intraoperative and postoperative blood transfusion with TXA use in these patients, the differences were not significant, possibly due to low estimated blood loss in both groups and sample size. Level of evidence III- retrospective comparative study

Risk of Sharp Device–Related Blood and Body Fluid Exposure in Operating Rooms

2008 ◽  
Vol 29 (12) ◽  
pp. 1139-1148 ◽  
Author(s):  
Douglas J. Myers ◽  
Carol Epling ◽  
John Dement ◽  
Debra Hunt
Keyword(s):  
Blood Loss ◽  
Surgical Procedures ◽  
Body Fluid ◽  
Operating Rooms ◽  
University Hospital ◽  
Operating Room Personnel ◽  
Surgical Equipment ◽  
Glove Perforation ◽  
Estimated Blood Loss ◽  
Duration Of Surgery

Objective.The risk of percutaneous blood and body fluid (BBF) exposures in operating rooms was analyzed with regard to various properties of surgical procedures.Design.Retrospective cohort study.Setting.A single university hospital.Methods.All surgical procedures performed during the period 2001–2002 (n = 60,583) were included in the analysis. Administrative data were linked to allow examination of 389 BBF exposures. Stratified exposure rates were calculated; Poisson regression was used to analyze risk factors. Risk of percutaneous BBF exposure was examined separately for events involving suture needles and events involving other device types.Results.Operating room personnel reported 6.4 BBF exposures per 1,000 surgical procedures (2.6 exposures per 1,000 surgical hours). Exposure rates increased with an increase in estimated blood loss (17.5 exposures per 1,000 procedures with 501–1,000 cc blood loss and 22.5 exposures per 1,000 procedures with >1,000 cc blood loss), increased number of personnel ever working in the surgical field (20.5 exposures per 1,000 procedures with 15 or more personnel ever in the field), and increased surgical procedure duration (13.7 exposures per 1,000 procedures that lasted 4–6 hours, 24.0 exposures per 1,000 procedures that lasted 6 hours or more). Associations were generally stronger for suture needle–related exposures.Conclusions.Our results support the need for prevention programs that are targeted to mitigate the risks for BBF exposure posed by high blood loss during surgery (eg, use of blunt suture needles and a neutral zone for passing surgical equipment) and prolonged duration of surgery (eg, double gloving to defend against the risk of glove perforation associated with long surgery). Further investigation is needed to understand the risks posed by lengthy surgical procedures.

scholarly journals Safety and Efficacy of Pressure-assisted Tissue-welding Tonsillectomy: A Preliminary Evaluation

2008 ◽  
Vol 87 (2) ◽  
pp. 100-112 ◽  
Author(s):  
Randall G. Michel ◽  
Bernard I. Weinstock ◽  
Kang Tsau
Keyword(s):  
Blood Loss ◽  
Postoperative Bleeding ◽  
Normal Diet ◽  
Intraoperative Blood Loss ◽  
Total Recovery ◽  
Safety And Efficacy ◽  
Tissue Welding ◽  
Welding Technology ◽  
The Mean ◽  
Clinic Visits

We conducted a retrospective study of the safety and efficacy of a new pressure-assisted tissue-welding technology (ENTceps; Starion Instruments Corp.; Sunnyvale, Calif.) for total tonsillectomy, either alone or with adenoidectomy. The use of this instrument was compared in two groups of patients categorized by age. The younger group was made up of 50 patients aged 2 to 12 years who had undergone total tonsillectomy and adenoidectomy (T&A), and the older group was made up of 50 patients aged 13 to 47 years who had undergone either T&A or isolated total tonsillectomy. The primary safety endpoint was the presence or absence of intra- or postoperative complications—particularly the amount of intraoperative blood loss and the incidence of delayed postoperative bleeding. In each group, the mean amount of intraoperative blood loss was no more than 30 ml, and only 2 of the 100 patients experienced postoperative hemorrhage. Among the efficacy parameters were the amount of operating and recovery time and the postoperative appearance of the tonsillar fossae. The mean operating time was 13.0 minutes in the younger group and 19.5 minutes in the older group, and the mean total recovery times were 120.0 and 130.4 minutes, respectively; all tonsillar fossae were well epithelialized by 2 weeks after surgery. Finally, surgical morbidity was determined on the basis of the amount of perioperative pain medication administered, the number of unscheduled patient telephone contacts and clinic visits, and the amount of time needed to return to a normal diet and activities. Nine patients in the younger group and 6 in the older group required no pain medications during recovery; overall, pain was not a significant issue for most patients. Sixteen patients made a total of 20 telephone calls and 8 clinic visits prior to their scheduled postoperative appointment; almost all of these encounters dealt with postoperative pain. Only 1 patient, who had previously undiagnosed von Willebrand disease, had not returned to a normal diet and activities by the end of 1 week. Based on our preliminary findings—and a comparison of our results with those of other studies published in the literature relative to the amount of intraoperative bleeding, the incidence of postoperative bleeding, and operating times—we conclude that pressure-assisted tissue-welding technology is safe and compares favorably with other tonsillectomy techniques. This method of electrocautery is straightforward and relatively easy to learn.

Von Willebrand Factor/Factor VIII Concentrate (Humate-P®) for Surgical Prophylaxis of Excessive Bleeding in Patients with Von Willebrand Disease (VWD).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1791-1791
Author(s):  
Joan Cox Gill ◽  
J. DiPaola ◽  
J. Bernstein ◽  
C. A. Leissinger ◽  
L. Valentino ◽  
...  
Keyword(s):  
Adverse Events ◽  
Surgical Procedures ◽  
Oral Surgery ◽  
Coagulation Factor ◽  
Major Surgery ◽  
Serious Adverse Events ◽  
Excessive Bleeding ◽  
Safety And Efficacy ◽  
Estimated Blood Loss ◽  
Von Willebrand

Abstract Optimal dosing to prevent excessive surgical bleeding in VWD is being investigated in an ongoing prospective, uncontrolled, open-labeled study to establish the safety and efficacy of replacement therapy with a VWF/FVIII concentrate (Humate-P®). This protocol-defined interim analysis describes the results in the first eighteen (18) patients (6 males, 12 females) of a total of 30 planned. Seven patients had Type 1 VWD, 6 had Type 2 (2 with 2A, 3 with 2B, 1 with 2M), and 5 had Type 3. All patients had pre-operative pharmacokinetic assessments to individualize the loading and maintenance doses of VWF/FVIII concentrate utilized for surgery. Fourteen patients had major surgical procedures including neurosurgery, joint replacement, tonsillectomy and complete oral restoration; three had minor procedures; and one had oral surgery. Hemostatic efficacy was assessed by investigators on a four-point scale (excellent, good, moderate/poor, none) immediately after surgery, 24 hours after the last VWF/FVIII concentrate infusion, and 14 days post-op. Good and excellent efficacy were combined into one endpoint of effective hemostasis. Expected estimated blood loss (EBL) was defined prior to the procedure, and actual EBL was recorded post-op. Adverse events were collected throughout the trial until follow-up 4 weeks post-op. Hemostasis was effective in 17/18 patients (94.4%) immediately after surgery; in 17/17 patients (100%) 24 hours after the last VWF/FVIII conc infusion; and in 18/18 (100%) patients 14 days after surgery. Median actual EBL did not exceed expected EBL in any surgery category. Four patients received transfusions (one for pre-existing anemia, three for serious adverse events). Loading doses of VWF/FVIII concentrate ranged from 36 to 135 IU/kg. Maintenance doses were determined by daily monitoring of plasma coagulation factor levels. Median durations of treatment were 2 days for oral surgery, and 4 days for both minor and major surgery. Post-op nausea (n=5) and fever (n=3) were the most commonly reported adverse events. Nausea, headache, and dizziness were considered possibly related to VWF/FVIII concentrate in one patient each; these events were mild in severity and resolved without sequelae. Bleeding-related serious adverse events were reported in three patients: one with GI bleeding post-laparoscopic gastro-jejunal bypass; one with post-craniotomy subdural and intracranial bleeding; and one with post-hysteroscopy/dilatation & curettage hemorrhage followed by hysterectomy. Hemostasis was considered effective in these 3 by the investigators, and in 2 patients by an independent DSMB review; hemostasis was considered ineffective by the DSMB only in the patient with post-hysteroscopy bleeding. No thromboembolic complications or changes in viral titers were observed. This analysis supports VWF/FVIII concentrate safety and efficacy to prevent excessive bleeding during and after a range of surgical procedures in patients with VWD. Enrollment in the trial continues.

Preoperative hematocrit and platelet count are associated with blood loss during spinal fusion for children with neuromuscular scoliosis

2021 ◽  
pp. 175045892096263
Author(s):  
Margaret O Lewen ◽  
Jay Berry ◽  
Connor Johnson ◽  
Rachael Grace ◽  
Laurie Glader ◽  
...  
Keyword(s):  
Platelet Count ◽  
Blood Loss ◽  
Spinal Fusion ◽  
Regression Trees ◽  
Classification And Regression Trees ◽  
Neuromuscular Scoliosis ◽  
Independent Variables ◽  
Estimated Blood Loss ◽  
Laboratory Results ◽  
Classification And Regression

Aim To assess the relationship of preoperative hematology laboratory results with intraoperative estimated blood loss and transfusion volumes during posterior spinal fusion for pediatric neuromuscular scoliosis. Methods Retrospective chart review of 179 children with neuromuscular scoliosis undergoing spinal fusion at a tertiary children’s hospital between 2012 and 2017. The main outcome measure was estimated blood loss. Secondary outcomes were volumes of packed red blood cells, fresh frozen plasma, and platelets transfused intraoperatively. Independent variables were preoperative blood counts, coagulation studies, and demographic and surgical characteristics. Relationships between estimated blood loss, transfusion volumes, and independent variables were assessed using bivariable analyses. Classification and Regression Trees were used to identify variables most strongly correlated with outcomes. Results In bivariable analyses, increased estimated blood loss was significantly associated with higher preoperative hematocrit and lower preoperative platelet count but not with abnormal coagulation studies. Preoperative laboratory results were not associated with intraoperative transfusion volumes. In Classification and Regression Trees analysis, binary splits associated with the largest increase in estimated blood loss were hematocrit ≥44% vs. <44% and platelets ≥308 vs. <308 × 109/L. Conclusions Preoperative blood counts may identify patients at risk of increased bleeding, though do not predict intraoperative transfusion requirements. Abnormal coagulation studies often prompted preoperative intervention but were not associated with increased intraoperative bleeding or transfusion needs.

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